Healthcare Provider Details

I. General information

NPI: 1598222622
Provider Name (Legal Business Name): ADDICTION PROFESSIONALS GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 02/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 S COAST HWY STE 763
LAGUNA BEACH CA
92651
US

IV. Provider business mailing address

1968 S COAST HWY STE 763
LAGUNA BEACH CA
92651-3681
US

V. Phone/Fax

Practice location:
  • Phone: 888-823-2233
  • Fax:
Mailing address:
  • Phone: 831-201-8386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL OBRIEN
Title or Position: CEO
Credential: CADC II
Phone: 888-232-2338